Honolulu leaders are working to reduce the high out-of-pocket costs for ambulance rides by pursuing a federal Medicaid program. Last Thursday, the City Council’s Public Safety Committee unanimously advanced Resolution 24, which asks the city and state to enroll Emergency Medical Services in the Ground Emergency Medical Transportation program. Supporters say GEMT could shift ambulance costs from patients to federal Medicaid funds, and the full Council is set to consider the measure on Feb. 18.
How GEMT works
GEMT allows eligible, publicly owned ambulance providers to claim supplemental Medicaid payments that help cover uncompensated costs and boost basic fee-for-service rates. According to the California Department of Health Care Services, participation is voluntary but comes with paperwork: providers must file cost reports approved by the Centers for Medicare & Medicaid Services and sign participation agreements with the state. Other states running GEMT programs rely on intergovernmental transfers and annual cost reports to determine payment levels, as outlined by MO HealthNet in Missouri.
City numbers: what it could mean for riders
State Department of Health figures presented at the hearing put Hawaii’s adjusted ambulance mileage rate for 2026 at $37.27 per mile. The adjusted emergency ambulance service rate is listed at $2,981 for advanced life support and $2,655 for basic life support. Resolution 24 notes that Medicaid currently covers about 70% of transport costs, which often leaves patients facing hefty co-pays. Supporters argue that GEMT reimbursements could fill that gap, covering out-of-pocket costs while also generating new revenue for the city’s EMS system.
At the committee meeting, Honolulu Emergency Services Department Director Dr. Jim Ireland told councilmembers that Medicaid typically reimburses only about $400 to $600 per EMS transport, far below the state’s published rates, according to the Honolulu Star-Advertiser.
Concerns about who benefits
Councilmembers and community advocates also warned that the GEMT pathway could create winners and losers if it is heavily shaped by outside contractors and billing firms. Councilmember Esther Kiaʻāina raised red flags about the role of the city’s consultant, saying it “could be a potential conflict of interest” during the Public Safety Committee hearing. HESD Director Ireland said his department supports the intent of the resolution but emphasized that the city will need state guidance and approval from the Department of Human Services before proceeding, according to the Honolulu Star-Advertiser.
Budget flows and the city’s EMS operations
Beyond patient relief, GEMT would change how ambulance dollars flow through local government. Participating states generally use intergovernmental transfers or similar mechanisms to cover the nonfederal share of the supplemental Medicaid payments. Honolulu’s Emergency Services Department has been updating its ambulance fleet and staffing in recent years, and department leaders told the Council they need clearly defined state rules before they attempt to join any federal-matching program. The mechanics can be complex; in other states, GEMT is administered through annual cost reports and provider agreements, as detailed by MO HealthNet, while Honolulu’s recent EMS upgrades have been documented by Hawaiʻi Public Radio.
What’s next
Resolution 24 now heads to the full Council, which will have to weigh state constraints, budget impacts and the role of consultants before making any formal request to the state. If Honolulu chooses to pursue GEMT, the city would need to work with state officials to document EMS costs, set up the nonfederal funding mechanism and secure the state approvals and agreements described by the California Department of Health Care Services.
Councilmembers said their priority is making sure no one hesitates to call 911 because they are afraid of the bill. The Feb. 18 vote by the full Council will determine whether Honolulu formally asks state officials to chase the federal match that could reshape ambulance billing on Oʻahu.
